Objectives To describe the mechanism of means testing used in health programs for targeting poor population and to describe how the authors have assessed effects of means testing approaches where applicable.
Method We searched 24 electronic resources which included evidence-based, health, economic and social databases, 7 international institution websites, grey literature review resources and Google. Screening and data extraction were conducted by two reviewers separately, and the differences were discussed by the third person or a review group. We systematically analyzed the included studied by theme analysis method from different dimensions. We also described the evaluation outcomes by the authors.
Result A total of 10244 records were searched, and 58 studies were included after screening by title, abstract and full texts. A total of 13 studies described verified means testing (VMT) conducted as a targeting method in the US; simple testing method (SMT) was conducted in 16 countries; 26 studies described how proxy means testing (PMT) was used in 14 countries; and
mixed means testing (MA) was conducted in 14 countries. Means testing as a targeting method was widely used in four health programs which included health insurance, cash transfer, provision of free health service and fee structure. The target population was poor. Only few studies analyzed the outcomes of means testing; 3 studies analyzed under-coverage and 11
studies analyzed leakage as their indicators. Scare cost information could be obtained from the included studies.
Conclusion Means testing is widely used in various health programs for targeting the eligible population in distributing benefits, especially in developing countries. Targeting as a means for allocating health resources is particularly important in LMICs for their constraints in budgets available for health. Meanwhile, a universal coverage strategy has become a worldwide issue, and how current health resources can be used equitably and efficiently is a concern from the policy practice. Means testing, as one of the tools in targeting eligible population, would help in this process.
Citation: JIA Liying,YUAN Beibei,YUAN Shasha,MENG Qingyue. Means Testing for Targeting Population in Health Programs: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(7): 773-783. doi: 10.7507/1672-2531.20100493 Copy